Quality control and stability of ketamine, remifentanil, and sufentanil syringes in a pediatric operating theater

• Published in: Pediatric anesthesia 2019-02, Vol.29 (2), p.193-199
• Main Authors: Bourdon, Florence, Simon, Nicolas, Lannoy, Damien, Berneron, Christophe, Décaudin, Bertrand, Reumaux, Laurence, Duhamel, Alain, Richart, Pierre, Odou, Pascal, Anderson, Brian
• Format: Article
• Language: English
• Subjects: Anesthetics, Intravenous - analysis; Chromatography, High Pressure Liquid; Drug Stability; Ketamine; Ketamine - analysis; Ketamine - chemistry; Life Sciences; Manufacturing; medication errors; Pediatrics - methods; Quality Control; remifentanil; Remifentanil - analysis; Remifentanil - chemistry; stability; sufentanil; Sufentanil - analysis; Sufentanil - chemistry; syringe compounding; Syringes
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.13563

Summary Background Transforming a drug from its commercial form into a ready‐to‐use drug is common practice, especially in pediatrics. However, the risk of compounding error is real and data on drug stability in practice are not always available. Aims The aim of this study was to assess, in real conditions, both the error rate and stability of three drugs: ketamine, remifentanil, and sufentanil. Methods A new rapid and easy‐to‐use high‐performance liquid chromatography method with a diode array detector has been developed and validated to quantify these drugs and detect their degradation products. Over a 1‐month period, 151 syringes were collected in the postanesthesia care unit. Seventy‐three were stock solution syringes containing a 10‐fold dilution of commercial drugs and 78 were serial dilution syringes made from successive dilutions of stock solutions. A comparison between real and expected concentrations as well as the detection of possible degradation products was carried out on these samples. Results All stock solution syringes had good chemical stability throughout the working day. A 4‐µg/mL remifentanil serial dilution syringe, however, had to be discarded as a degradation peak was detected. Overall, 15.3% (95% CI, 9.5‐21.1%) of syringes had a drug concentration outside the ±10% acceptability range, that is, 11.0% (95% CI, 3.7‐18.2%) and 19.5% (95% CI, 10.6%‐28.4%) of stock and diluted syringes respectively, with drug amounts ranging from −25.3% to 22.0%. The highest error rates were observed with sufentanil syringes: 20% and 28% for stock solution and serial dilution, respectively. Conclusion The study shows that stock solution syringes prepared in advance are chemically stable throughout the day, unlike certain serial dilution syringes, indicating that the latter should be prepared just before administration to ensure chemical stability. Our results show that the error rate for serial dilution syringes is twice that of stock solution. Different safety measures are under discussion and have to be further studied.